|James G. Ramsay,
What makes a cardiothoracic anesthesiologist?
Some weeks ago, the SCA sent an email message to all members (with email addresses) announcing the proposal by the Accreditation Council for Graduate Medical Education (ACGME) regarding training program requirements for cardiothoracic anesthesiology. By the time you read this message, the comment period will have closed (November 18); I hope many of you made use of this important opportunity. If you do not have an up-to-date email address on file at SCA headquarters please contact Heather Spiess NOW (firstname.lastname@example.org) before reading further!
"The mission of the ACGME is to improve the quality of health care in the United States by ensuring and improving the quality of graduate medical education for physicians in training" (from the ACGME website). This private, non-profit council works closely with the Residency Review Committees (RRCs) of the medical specialties, as well as the major specialty groups such as ASA. The proposal on the ACGME website was for separate one year fellowships for pediatric and adult cardiothoracic anesthesiology.
For those of you who may not have been following this process, the appearance of the training program proposal by the ACGME is a very important step towards the recognition of cardiothoracic anesthesiology as a subspecialty in the United States. Once the proposal has been accepted, this will lead to ACGME accreditation of training programs, placing the subspecialty of cardiothoracic anesthesiology on the same educational foundation as cardiothoracic surgery and cardiology.
At the ACGME website, when you access the program requirements you can also access the "criteria document." The latter is the very persuasive and complete argument made by the SCA task force, appointed by the SCA Board more than eight years ago and headed by past president Alan Jay Schwartz. While this document reflects a large component of the work of the task force, Dr. Schwartz and his task force have also expended a major effort to elicit support from leaders in anesthesiology and in other specialties who provide care for the cardiothoracic surgery patient. It would be fair to say that successive presidents and boards of the SCA for the last 10 years have considered this to be a priority of the society, whose mission is to promote "excellence in patient care through education and research in perioperative care for patients undergoing cardiothoracic and vascular procedures." What could be more important or relevant to this mission than assuring a core program of knowledge, case-type exposure, and specific expertise for subspecialist cardiothoracic anesthesiologist trainees?
When you read the "criteria document" and the proposed program requirements, you will see what your society believes "makes" a cardiothoracic anesthesiologist. While one can quibble about some details, these documents indicate the broad range of experience, as well as the type of environment required, for the creation of a subspecialist. In addition, we expect a year of training in adult cardiothoracic anesthesiology to provide adequate exposure and training in transesophageal echocardiography (TEE) to enable the fellow to be eligible for certification by the National Board of Echocardiography (NBE).
One of the issues surrounding the creation of a new subspecialty is: what happens to the old guys like me? I need to be very clear on this point: creation of a subspecialty with program requirements and ACGME accreditation of training programs does NOT mean certification of individuals. My practice of cardiothoracic anesthesiology will continue as in the past, and I will continue to call myself a cardiothoracic anesthesiologist. In addition to staying abreast of new procedures and developments in our field, I need to continue to develop my knowledge of TEE, as during my "fellowship" year in 1983, (my final year of training in anesthesiology in Canada), TEE was in its infancy. Like many of you, I am working on the "practice experience pathway" towards eventual certification in TEE, according to the criteria defined by the NBE. With recognition of the subspeciality of cardiothoracic anesthesiology and accreditation of training programs, the professional prestige for those of us currently in practice will be enhanced, as we will be recognized as the pioneers and mentors of the new breed of subspecialists.
The process of creating the new subspecialty of cardiothoracic anesthesiology appears to be "on track" to become a reality under my watch (ie, within the next two years or so). I can only take credit for being one of many individuals at the SCA who has strongly supported the cause. The real credit goes to the vision of past president Richard Davis who put the subject on the table and created the task force, and of course to Alan Jay Schwartz and his task force who have guided the process to date.
James G. Ramsay, MD